Adhesive Capsulitis Overview

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Questions and Answers

What is a key characteristic of the thawing stage in shoulder rehabilitation?

Return of motion (correct)

Significant loss of motion

Complete restoration of normal function

Return of normal capsular volume

Why should aggressive stretching be avoided in the rehabilitation of diabetic patients?

It can cause inflammation in the joint

It does not significantly improve range of motion (correct)

It may lead to a complete loss of motion

It can damage muscle fibers

What initial treatment strategy is recommended during the thawing stage?

Performing heavy weight lifting

Using only soft tissue techniques

Mobilizing the scapula gently (correct)

Aggressive joint manipulation

Which muscles should be targeted with soft tissue techniques to reduce tension before stretching?

Subscapularis, pectoralis minor, and external rotators (A) Signup and view all the answers

What is advised regarding the movement of the clavicle during treatment?

Move it anteriorly while supporting the arm (B) Signup and view all the answers

What is the primary focus of treatment during the freezing stage of shoulder rehabilitation?

Maintenance of range without pushing to end range (C) Signup and view all the answers

Which technique is recommended for pain modulation during the painful stage?

Transcutaneous electrical neuromuscular stimulation (TENS) (D) Signup and view all the answers

In which stage of shoulder rehabilitation do patients typically experience minimal pain but demonstrate a limitation of motion?

Frozen Stage (C) Signup and view all the answers

What exercise is suggested for patients to help facilitate return to sleep if awakened by pain during the freezing stage?

Codman exercises in a relaxed posture (B) Signup and view all the answers

Which statement about the treatment of the frozen stage is true?

Strengthening exercises can be performed within the available range (B) Signup and view all the answers

What is a characteristic symptom of adhesive capsulitis?

Progressive pain and stiffness of the shoulder (D) Signup and view all the answers

What is the typical age range for the onset of adhesive capsulitis?

40-60 years (A) Signup and view all the answers

Which condition is particularly associated with adhesive capsulitis?

Diabetes (D) Signup and view all the answers

Which phase is NOT part of the natural progression of adhesive capsulitis?

Loss of sensation (C) Signup and view all the answers

What is the expected duration before adhesive capsulitis typically resolves spontaneously?

18 months (C) Signup and view all the answers

Which of the following is a diagnostic criterion for adhesive capsulitis?

Painful restriction of movement with normal X-rays (D) Signup and view all the answers

What may happen to shoulder movement after recovery from adhesive capsulitis?

Some pain may persist and movement may not be normal (A) Signup and view all the answers

What common misconception exists regarding the stiffness that develops with adhesive capsulitis?

Stiffness can continue for 6-12 months after pain subsides (D) Signup and view all the answers

Study Notes

Adhesive Capsulitis (Frozen Shoulder)

A well-defined disorder causing progressive pain and stiffness in the shoulder
Symptoms usually resolve spontaneously after about 18 months
Cause is unknown
Associated with conditions like diabetes, Dupuytren's disease, hyperlipidemia, hyperthyroidism, cardiac disease, and hemiplegia
Can sometimes occur after recovery from neurosurgery

Clinical Features

Patients are typically aged 40-60
Often preceded by a history of (sometimes minor) trauma
Pain gradually increases in severity, preventing sleeping on the affected side
Pain subsides after several months, but stiffness typically persists for another 6-12 months
Movement may return but not always to full normal range, and some pain may persist
Active and passive movement is limited in all directions

Diagnosis

Characterized by painful restriction in movement despite normal X-rays
Follows a natural progression through three phases

Treatment

Analgesics and anti-inflammatory drugs
Physical therapy and rehabilitation
Manipulation under general anesthesia

Physical Therapy

Painful Stage: Use pain modulation techniques (e.g., TENS), and avoid aggressive stretching exercises. Patients position themselves to minimize the affected limb use. Instead of passive postures, ask patients to involved the unaffected arm to support the affected arm. Codman and posture exercises may be used.
Freezing Stage: Focus on maintaining the current range of motion. Gentle extension, within the available range, is necessary but avoiding reaching the limit of motion. The use of pillows or thoracic positioning may be recommended to promote sleep. No aggressive stretching or resistance exercises should be performed. Encourage patients to "climb the wall" in the scapular plane
Frozen Stage: Patients demonstrate motion limitation, but pain is minimal. Exercise and range of motion work within end-range are encouraged, as well as strengthening exercise. Manipulations can be used at this stage.
Thawing Stage: Return of motion is a hallmark, but capsular volume is often not restored. Variety of stretching maneuvers may be effective. Treatments for this stage include mobilizing the scapula-move the scapula over the fingers, mobilize the clavicle, and soft tissue techniques like those on rotators, pectoral muscle, etc.

Differential Diagnosis

In patients with diabetes, signs of inflammation may be absent during the initial stages
Severe shoulder injury may cause stiffness, but usually pain gradually lessens
The pattern of pain and stiffness following a forearm fracture differs from a typical frozen shoulder

Important Considerations

Patients with diabetes may have a less favorable response to manipulation, even in the frozen stage
Aggressive stretching is not recommended during the early stages

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Description

This quiz covers adhesive capsulitis, commonly known as frozen shoulder. It includes information about clinical features, diagnosis, and associated conditions. Ideal for medical students and healthcare professionals looking to deepen their understanding of this disorder.